Ketogenic Diet and Epilepsy: What We Know So Far

The Ketogenic Diet (KD) is a modality of treatment used since the 1920s as a treatment for intractable epilepsy. It has been proposed as a dietary treatment that would produce similar benefits to fasting, which is already recorded in the Hippocratic collection. The KD has a high fat content (90%) and low protein and carbohydrate. Evidence shows that KD and its variants are a good alternative for non-surgical pharmacoresistant patients with epilepsy of any age, taking into account that the type of diet should be designed individually and that less-restrictive and more-palatable diets are usually better options for adults and adolescents. This review discusses the KD, including the possible mechanisms of action, applicability, side effects, and evidence for its efficacy, and for the more-palatable diets such as the Modified Atkins Diet (MAD) and the Low Glycemic Index Diet (LGID) in children and adults

Estimulador do nervo vago: taxa e predição de resposta em pacientes adultos e crianças com epilepsia farmacorresistente

JUSTIFICATIVA: Aproximadamente 50 milhões de pessoas no mundo têm epilepsia e 80% delas vivem em países de baixa e média renda. Sabe-se que cerca de 30% dos pacientes com epilepsia não irão ficar totalmente livres de crises após o uso de dois ou mais anticonvulsivantes efetivos e bem tolerados. Esta condição é conhecida como epilepsia refratária e está associada a taxas elevadas de morbimortalidade. Apesar de a cirurgia para epilepsia ser a principal opção para esses pacientes refratários, muitos não são candidatos a esse tratamento. Assim, é necessário oferecer outras opções para esses pacientes, tais como dieta cetogênica e neuromodulação. A terapia estimulação do nervo vago (VNS - Vagus Nerve Stimulation) é uma terapia de neuromodulação que consiste na aplicação de estímulos elétricos sob o nervo vago, e é aprovada como tratamento adjuvante para epilepsias refratárias na Europa (1994), Estados Unidos (1997) e Brasil (2000). Tem sido demonstrado que a terapia VNS apresenta eficácia em reduzir a frequência de crises em 50% em cerca de 50% dos pacientes, mas as características dos pacientes que apresentam melhor resposta ainda não foram identificadas. Deste modo, é importante tentar identificar o perfil dos pacientes que teriam melhor resposta a fim de guiar a indicação precoce e com isso reduzir os custos do tratamento. OBJETIVO: O objetivo do estudo é avaliar a taxa de resposta de crianças e adultos à terapia VNS e identificar variáveis relacionadas com a melhor resposta. METODOLOGIA: Estudo transversal com dados doados de pacientes epilépticos refratários, advindos de seis centros de epilepsia do Brasil, em uso de VNS como terapia adjuvante. Foram excluídos deste estudo pacientes com menos de seis meses de gerador ligado. RESULTADOS: Dados coletados de 191 pacientes entre três e 69 anos, com 54,4% de homens e 45,55% de mulheres. Observou-se que 127 (66,4%) dos pacientes responderam à terapia VNS, dentre os quais 10 (5,2%) ficaram livres de crises. Déficit intelectual estava presente em 115 (60,4%) dos pacientes, havendo 22 (11,5%) com síndrome de Lennox Gastaut. A maioria dos pacientes (92,7%) apresentava alterações no eletroencefalograma (EEG), dos quais 114 (60,9%) apresentavam atividade focal e 79 (41.6%), generalizada. Quanto à caracterização das crises, foram observados 100 pacientes (51%) com crise focal, 51 (25,5%) com crise generalizada e 40 (23,4%) com crise de padrão multifocal. As variáveis estatisticamente significativas para melhor resposta foram: sexo feminino (p=0,014), ausência de deficiência mental (p=0,05), ausência de síndrome de Lennox Gastaut (p=0,012), atividade focal no EEG (p=0,005), crise focal (p=0,003) e ausência de neurocirurgia prévia (p=0,008). CONCLUSÃO: A terapia VNS é adjuvante, eficaz e bem tolerada para pacientes com epilepsia refratária. Notavelmente, pacientes do sexo feminino, a presença de descargas epileptiformes focais isoladas e apresentação de crises focais aparentam ser variáveis preditoras de resposta à terapia VNS na população brasileira. A ausência de síndrome de Lennox Gastaut, ausência de deficiência mental e ausência de neurocirurgia prévia foram relacionadas com boa respostaJUSTIFICATION: Approximately 50 million people globally have epilepsy and 80% of them live in low and middle income countries. It is well recognized that 30% of the epileptics patients will not achieve seizure freedom after two or more tolerate and effective anti epileptics drugs. This condition is known as refractory epilepsy and it has an elevate morbimortality rate. Despite of epilepsy surgery be the major treatment for this group, several patients are not candidate. For them it is necessary to propose others options as cetogenic diet or neuromodulation. Vagus nerve stimulation (VNS) is a neuromodulation therapy, approved in Europe (1994), USA (1997) and Brazil (2000) as adjunctive for treatment for refractory epilepsies, which an electrical stimulus is applied in the cervical vagus nerve. It has been demonstrated that VNS is effective in reducing seizure frequency over than 50% in approximately 50% of patients, but better responders patients characteristics is not clear. It is important to identify who will be the best responders to guide an early indication and reduce costs in the treatment. OBJECTIVE: The objective of the present study was to evaluate the response rate of adults and children implanted with VNS and identify variables for better response to VNS therapy. METHODOLOGY: Cross-sectional study with donated data of medically intractable epilepsy patients and in use of VNS therapy from 6 epilepsy centers in Brazil. Were excluded from this study patients with less than 6 months of VNS implant. RESULTS: Data from 191 patients (3 to 69 years), 54,4% male and 45,55% female, was collected from patients charts. We observed 127 (66,4%) with respond to VNS therapy which 10 patients (5,2%) were seizure free. Mental disability was seen in 115 (60,4%) patients, 22 (11,5%) had Lennox Gastaut syndrome. The majority of patients, 177 (92,7%) had electroencephalogram (EEG) abnormalities in which 114 (60,9%) had focal activity and 79 (41,6%) generalized activity. Regarding seizure characterization it was observed 100 patients (51%) with focal seizure, 51 (25.5%) with generalized seizures and 40 (23.4%) with multiple seizure patterns. The statistically significant variables for better response were: female gender (p=0,014), absence of mental disability (p=0,05), absence of Lennox Gastaut syndrome (p=0,012), focal activity in the EEG (p=0,005), focal seizure (p=0,003) and absence of prior neurosurgery (p=0,008). CONCLUSION: VNS is a well-tolerated and effective adjuvant therapy in patients with intractable epilepsy. Notably, female patients, presence of isolated focal epileptiform discharges and focal seizures maybe better features associated with good response to VNS in Brazilian population. The absence of Lennox Gastaut syndrome, absence of mental disability and absence of prior neurosurgery was correlated with good response63f

NANOTECNOLOGIA E ENSINO DE CIÊNCIAS:UMA VIAGEM A LILLIPUT

O Ensino de Ciências deve ser organizado de modo a formar estudantes capazes de entender o mundo no qual estão inseridos. Com o objetivo de discutir a nanotecnologia na perspectiva do enfoque de Ciências, Tecnologia e Sociedade, à luz da interdisciplinaridade, foi realizada uma revisão bibliográfica pertinente e estabelecidos quatro eixos temáticos, os quais poderão ser abordados em sala de aula

Use of lacosamide in children: experience of a tertiary medical care center in Brazil

Background Lacosamide (LCM) is a third-generation anti-seizure drug approved in Europe and the United States, either as a monotherapy or adjunctive therapy, to treat partial-onset seizures in adults, adolescents, and children. In Brazil, LCM is licensed for treatment only in patients older than 16 years of age. Objective To evaluate a cohort of children presenting with refractory epilepsy who received LCM as an add-on therapy and observe the response and tolerability to the LCM treatment. Methods A retrospective cohort study conducted in a tertiary health care facility, which included 26 children, aged up to 16 years, who presented with refractory epilepsy and received LCM as an add-on treatment. The follow-up visits were scheduled every 3 months until 9 months of treatment with LCM. Results After 3 months of LCM administration, in 73.1% of the children, there was a reduction of > 50% in the frequency of seizures, and this clinical improvement was maintained in most patients (73.9%) for the following 9 months. Mild (such as, somnolence and behavioral changes) or severe (seizure worsening) adverse effects were observed in two and three children respectively. Among responders to LCM, there was a higher prevalence of males, fewer concomitant anti-seizure drugs, and lower percentage of patients using sodium channel blockers. Conclusions Lacosamide should be considered as an early treatment option in pediatric patients with refractory epilepsy, mainly focal seizures

Nanociência e nanotecnologia como temáticas para discussão de ciência, tecnologia, sociedade e ambiente

Scientific and technological education has been, in present times, fairly-well discussed, with focus on the ultimate commitment of the various teaching institutions: to promote the formation of citizens who are able to understand the world where they live in. Actually, the choice of contemporary topics is by itself a very strategic approach to motivate discussions on such matters in the classroom. Nanoscience and nanotechnology come up very properly in such a domain, which can be treated in an interdisciplinary way, by joining exact and natural sciences on the one hand, and human and social sciences on the other hand. The proposal of thematic directions to approach nanoscience and nanotechnology as a motto for science teaching, set up from reviewing the literature under the optics of Science-Technology-Society-Environment (STSE), is the main goal of the present paper.A educação científica e tecnológica tem sido intensamente discutida hodiernamente, tendo em vista o compromisso último das diferentes instituições de ensino: formar cidadãos capazes de entender o mundo no qual estão inseridos. Com efeito, a apreciação de temas da atualidade se constitui em abordagem bastante salutar para motivar as discussões sobre tais temáticas em sala de aula. Neste domínio se inserem a nanociência e a nanotecnologia, saberes que podem ser abordados de forma interdisciplinar, envolvendo as ciências exatas e da natureza de forma articulada às ciências humanas e sociais. A proposição de eixos temáticos para o emprego da nanociência e da nanotecnologia como mote para o ensino de ciências, construídos a partir da revisão da literatura sob um enfoque ciência-tecnologia-sociedade-ambiente (CTSA) é o escopo do presente artigo